- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.75 / $28.74 / $48.02
| Professional | | $19.75 | $28.74 | $48.02 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $6.68 / $13.02 / $18.04
| Professional | 52 | $6.68 | $13.02 | $18.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.55 / $31.55 / $43.12
| Professional | | $31.55 | $31.55 | $43.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.60 / $34.34 / $43.65
| Professional | | $27.60 | $34.34 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.43 / $31.68 / $46.08
| Facility | | $18.43 | $31.68 | $46.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.68 / $28.74 / $43.65
| Professional | | $20.68 | $28.74 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.22 / $44.46 / $52.26
| Professional | | $38.22 | $44.46 | $52.26 |